"use strict";
exports.__esModule = true;
exports.claim = void 0;
exports.claim = {
    bill_name: 'NEW TEST COMPANY',
    bill_addr_1: '1212 COURT ST',
    bill_addr_2: 'ADDRESS 2',
    bill_city: 'CLEARWATER',
    bill_state: 'FL',
    bill_zip: '337629998',
    pcn: '4F3MWL79W6O',
    mrn: 'MRN',
    type_of_bill: '011',
    bill_taxid: '118425883',
    fdos: '01-21-2021',
    ldos: '01-22-2021',
    pat_name_l: 'JACOB',
    pat_name_f: 'MIKE',
    pat_addr_1: '123 W 2ND AVE',
    pat_city: 'LAKELAND',
    pat_state: 'GA',
    pat_zip: '22222',
    pat_country: 'CC',
    pat_dob: '07-24-1985',
    pat_sex: 'M',
    hosp_from_date: '02-02-2020',
    admit_hour: '23',
    admit_type: '4',
    admit_source: '1',
    disch_status: '01',
    cond_code_1: '18',
    cond_code_2: '19',
    cond_code_3: '20',
    cond_code_4: '21',
    cond_code_5: '22',
    cond_code_6: '23',
    cond_code_7: '24',
    occ_code_1: 'CO',
    occ_date_1_date: '12-12-2009',
    occ_code_2: '43',
    occ_date_2_date: '12-12-2009',
    occ_code_3: '4',
    occ_date_3_date: '12-12-2009',
    occ_code_4: '4',
    occ_date_4_date: '12-12-2009',
    span_code_1: '43',
    span_from_1_date: 'span_fro',
    span_thru_1_date: 'span_thr',
    occ_code_5: '32',
    occ_date_5_date: '12-12-2020',
    occ_code_6: '54',
    occ_date_6_date: '12-12-2009',
    occ_code_7: '76',
    occ_date_7_date: '12-12-2009',
    span_code_2: '98',
    span_from_2_date: '12-12-2009',
    span_thru_2_date: '12-12-2009',
    value_code_1: 'AQ',
    value_amt_1: '112.00',
    value_code_2: '1W',
    value_amt_2: '11.00',
    value_code_3: 'C1',
    value_amt_3: '44.00',
    value_code_4: 'C4',
    value_amt_4: '55.00',
    value_code_5: 'C6',
    value_amt_5: '66.00',
    value_code_6: 'C7',
    value_amt_6: '77.00',
    value_code_7: 'BC',
    value_amt_7: '11.00',
    value_code_8: 'C2',
    value_amt_8: '22.00',
    value_code_9: 'C3',
    value_amt_9: '3300',
    value_code_10: 'C1',
    value_amt_10: '10.00',
    value_code_11: 'C9',
    value_amt_11: '99.00',
    value_code_12: 'C8',
    value_amt_12: '88.00',
    charges: [{
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }, {
            rev_code: '12354',
            proc_code: 'H0031',
            mod1: 'TR',
            mod2: 'TS',
            mod3: 'TG',
            mod4: 'HG',
            from_date: '01-21-21',
            units: '1',
            charge: '90.00',
            ncov_amount: '20.00',
            narrative: '77777777'
        }],
    rev_code_1: '00001',
    proc_code_1: 'H0031',
    rate_1: '0.11',
    mod1_1: 'TR',
    mod2_1: 'TS',
    mod3_1: 'TG',
    mod4_1: 'HG',
    from_date_1: '01-21-21',
    units_1: '1',
    charge_1: '90.00',
    ncov_amount_1: '20.00',
    narrative_1: '77777777',
    rev_code_2: '00001',
    proc_code_2: 'H0031',
    rate_2: '0.11',
    mod1_2: 'TR',
    mod2_2: 'TS',
    mod3_2: 'TG',
    mod4_2: 'HG',
    from_date_2: '01-21-21',
    units_2: '1',
    charge_2: '90.00',
    ncov_amount_2: '20.00',
    narrative_2: '77777777',
    total_charge: '180.00',
    bill_npi: 'bill_npi',
    payer_order: 'PRIMARY',
    payerid: '200',
    info_release: 'Y',
    accept_assign: 'Y',
    pat_due: '50',
    bill_taxonomy: '103TW0100X',
    other_payer_name: 'LJH',
    other_payerid: '34',
    bill_id: '344',
    ins_name_l: 'JACOB',
    ins_name_f: 'MIKE',
    pat_rel: '18',
    ins_number: '34',
    ins_plan: '43',
    ins_group: '54',
    other_ins_name_l: '543664',
    other_pat_rel: '40',
    other_ins_number: '6544',
    other_ins_plan: '654654',
    other_ins_group: '4674',
    auth_code_1: '1277',
    icn_dcn_1: '4347',
    ins_employer: 'ins_employer',
    auth_code_2: '3777',
    icn_dcn_2: '35435',
    diag_1: 'A',
    diag_2: 'B',
    diag_3: 'C',
    diag_4: 'D',
    diag_5: 'E',
    diag_6: 'F',
    diag_7: 'G',
    diag_8: 'H',
    diag_9: 'I',
    diag_10: 'J',
    diag_11: 'K',
    diag_12: 'L',
    diag_13: 'M',
    diag_14: 'N',
    diag_15: 'O',
    diag_16: 'P',
    diag_17: 'Q',
    diag_18: 'R',
    diag_19: 'S',
    diag_20: 'T',
    diag_21: 'U',
    diag_22: 'V',
    diag_23: 'W',
    diag_24: 'X',
    diag_25: 'Y',
    diag_26: 'Z',
    admit_diag: '1',
    e_code: '2',
    e_code_1_poa: '3',
    e_code_2: '4',
    e_code_3: '5',
    drg: '6',
    prov_npi: '1184258832',
    prov_name_l: 'GH',
    prov_name_f: 'YH',
    prov_id: 'ID1',
    prov_taxonomy: 'TAXN',
    prov2_npi: '1',
    prov2_name_l: '3',
    prov2_name_f: '333',
    prov2_id: 'ID2',
    prov2_taxonomy: 'TAXN1',
    prov3_npi: '2',
    prov3_name_l: 'OTHER1',
    prov3_name_f: 'OTHER1',
    prov3_id: 'ID3',
    prov3_taxonomy: 'TAXN3',
    ref_npi: '1432657',
    ref_name_l: 'REFERRING',
    ref_name_f: 'REFERRING2',
    proc_clmcode_1: '5435',
    proc_date_1_date: '01-21-21',
    proc_clmcode_2: 'HFG',
    proc_date_2_date: '01-21-21',
    proc_clmcode_3: 'HHFG',
    proc_date_3_date: '01-21-21',
    proc_clmcode_4: '546',
    proc_date_4_date: '01-21-21',
    proc_clmcode_5: '434',
    proc_date_5_date: '01-21-21',
    proc_clmcode_6: '434',
    proc_date_6_date: '01-21-21',
    narrative: '4234324324234',
    ins_addr_1: '34343543',
    ins_addr_2: '5435435634',
    ins_city: 'YYY',
    ins_state: 'HG',
    ins_zip: '5444',
    payer_name: 'LXJ',
    facility_npi: '1184258832',
    pay_addr_1: 'PAY TO',
    pay_addr_2: 'ADDRESS 2',
    pay_city: 'CITY',
    pay_state: 'ST',
    pay_zip: '11'
};
